naturally ocurring food toxins

7/22/2019 Naturally Ocurring Food Toxins

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Toxins2010, 2, 2289-2332; doi:10.3390/toxins2092289

toxinsISSN 2072-6651

www.mdpi.com/journal/toxins

Review

Naturally Occurring Food Toxins

Laurie C. Dolan *, Ray A. Matulkaand George A. BurdockBurdock Group, 801 N. Orange Ave., Suite 710, Orlando FL 32801, USA;

E-Mails: [email protected] (R.A.M.); [email protected] (G.A.B.)

* Author to whom correspondence should be addressed; E-Mail: [email protected];Tel.: +1-407-802-1400; Fax: +1-407-802-1405.

Received: 12 August 2010; in revised form: 2 September 2010 / Accepted: 13 September 2010 /

Published: 20 September 2010

Abstract: Although many foods contain toxins as a naturally-occurring constituent or, are

formed as the result of handling or processing, the incidence of adverse reactions to food is

relatively low. The low incidence of adverse effects is the result of some pragmatic

solutions by the US Food and Drug Administration (FDA) and other regulatory agencies

through the creative use of specifications, action levels, tolerances, warning labels and

prohibitions. Manufacturers have also played a role by setting limits on certain substances

and developing mitigation procedures for process-induced toxins. Regardless of measures

taken by regulators and food producers to protect consumers from natural food toxins,

consumption of small levels of these materials is unavoidable. Although the risk for

toxicity due to consumption of food toxins is fairly low, there is always the possibility of

toxicity due to contamination, overconsumption, allergy or an unpredictable idiosyncratic

response. The purpose of this review is to provide a toxicological and regulatory overviewof some of the toxins present in some commonly consumed foods, and where possible,

discuss the steps that have been taken to reduce consumer exposure, many of which are

possible because of the unique process of food regulation in the United States.

Keywords: toxin; natural; environmental; exposure; processing; cooking; food

1. Introduction

Historically, we have learned that everything is toxic; it is only the dose that separates the toxic

from the non-toxic. Even water is toxic if a large amount (45 liters) is consumed in a relatively short

OPEN ACCESS


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time (23 hours). The pathogenesis of water intoxication includes hyponatremia, followed by cerebral

edema, seizures and death.

Like water, too much of a good thing such as the antioxidant vitamin A, can have acute toxic effects

leading to hepatotoxicity [1] or chronic high levels can have a pro-oxidant effect [2]. Something as

innocent as licorice, when consumed in large amounts may be harmful. For example, Bannister and

associates reported hypokalemia leading to cardiac arrest in a 58-year-old woman who had been eating

about 1.8 kg of licorice per week [3]. This licorice in toxication (dubbed glycyrrhizism after

glycyrrhizic acid, the active component of licorice), has an effect resembling that of aldosterone, which

suppresses the renin-angiotensin-aldosterone axis, resulting in the loss of potassium. Clinically,

hypokalemia with alkalosis, cardiac arrhythmias, muscular symptoms together with sodium retention

and edema, and severe hypertension are observed. The syndrome may develop at a level of 100 g

licorice per day but gradually abates upon withdrawal of the licorice [4].

Recently, public health and social agendas have become more proactive in food toxicology, such asregulating (or outright banning) trans fats or endocrine disruptors in foods on the basis of public

safety, including a suggestion of removing the generally recognized as safe (GRAS) status for salt [5].

These agendas lose sight of the basic principle of toxicology that the dose makes the poison and that

demanding safetyper se or safe at any dose, for all foods and ingredients is a non-starter and as a

concept, was abandoned with the adoption of the Federal Food and Drug Act (FFDCA) in 1958. For

their part, the regulators can limit amounts of potentially toxic substances allowed in food and in those

circumstances where setting limits is not effective and public health policy makers provide the public

with sufficient information (e.g., label information), where possible, to protect the consumer from

reasonably foreseeable problems. Labeling requirements by the FDA provide the consumer withhelpful information about content of fats, carbohydrate, protein, potential allergens, caloric value, etc.,

but do not provide information about toxins that may be inherent in the foods or formed during

processing. Because some food toxins cannot be removed from foods and others may be created during

processing or cooking, consumption of small quantities of food toxins is unavoidable. The purpose of

this review is to illustrate the potential risks of these toxins when consumed at concentrations normally

present in foods and the steps taken by regulators to mitigate exposure where possible. Although

regulatory information from countries other than the United States is included, FDA legislation is

emphasized. Readers from other countries are advised to consult regulations for their specific region,

because regulations and regulatory practices in other countries may differ from those in the United States.

2. Regulatory Accommodation

Foods are regarded as such because they are ediblethey cannot be unpalatable or toxicand;

foods must have nutritional, hedonic or satietal valueotherwise there would be no point in

consuming them. Therefore, in the absence of a spontaneous change or contamination, the concept of a

toxic food per se would seem to be an oxymoron. How then, could a food be toxic and still be

considered a foodthere are two principal means: (1) an ordinarily non-toxic food has become toxic,

if even for a small subpopulation; and (2) over-consumption of an ordinarily non-toxic food. This shiftbetween toxic and non-toxic or toxic only for a select group has the potential for creating headaches for

regulatory agencies charged with protecting the health of the public, but as the reader will see in the


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following pages, the FDA and other regulatory agencies have created some thoughtful and pragmatic

solutions for achieving a balance of acceptable risk and unavoidable circumstances.

The large diversity of acceptable foods made it difficult for the framers of the Federal Food Drug

and Cosmetic Act (FFDCA) to define what a food could be, so they settled on the pragmatic definition

provided in 201(f) [6]:

The term foodmeans (1) articles used for food or drink for man or other animals, (2) chewing gum, and

(3) articles used for components of any such article.

The framers are to be congratulated on their realistic approach, but a little interpretation is required.

In the first clause articles used for food... includes what humans and animals will eat as such

(including eggs, meat, kohlrabi, Velveetacheese and angel food cake). The third clause articles used

for components of any such article, are simply those substances used to make food (defined in the first

clause)therefore, anything approved for addition to food, becomes a part of the food. The second

clause was more of a political consideration than anything else, as there was some disagreement

whether chewing gum was swallowed or expectorated; the swallowers prevailed and chewing gum is

regulated as a food. Had the majority determined that chewing gum was expectorated (as is evident on

a sidewalk outside of any theater or church), it would have been classified with breath mints (which are

not swallowed) and are therefore regulated as a cosmetic, whose function is to promote

attractiveness of the body[6]. It has also been ruled by the FDA that proposed dietary supplements

(which are regulated as a subset of foods) meant to be held in the mouth, followed by expectoration,

are not dietary supplements, because they are not swallowed.

The definition of food has generally held since the 1958 definition, although it was changed slightlyin the 7th Circuit in 1983, to now indicate that a food is something consumed primarily, for [its]

taste, aroma or nutritive value. This court decision did not radically change the definition of food from

the original context, but in this particular case, prohibited the use of a food extract for therapeutic

intent (i.e., amylase isolated from kidney beans as an inhibitor of carbohydrate breakdown and

marketed for weight lossso-called starch blockers).

In general, the law prohibits the sale of food if it consists in whole or in part of any filthy, putrid, or

decomposed substance, or if it is otherwise unfit for food (in practice, fitness can be quite

subjective). Also, some foods which are ordinarily safe to eat may become unsafe, as described in 402

of the FFDCA [7]:

402. A food shall be deemed to be adulterated(a) (1) If it bears or contains any poisonous or deleterious

substance which may render it injurious to health; but in case the substance is not an added substance such

food shall not be considered adulterated under this clause if the quantity of such substance in such food does

not ordinarily render it injurious to health

The first part of 402 is clear; if a food contains a poisonous or deleterious substance it cannot be

used as a fooda fairly broad standard. The second part of the section but in case the substance is

not an addedthe quantity of such substance does not ordinarily render it injurious to health

requires an explanation. This clause simply means that although toxic substances may be present infoods, the food is not adulterated if the amount present in the food is not ordinarily injurious to health.

For example, tomatine in tomatoes, psoralens in celery or glycoalkaloids in potatoes are normally


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present in concentrations that are not harmful; however, in the event these amounts are increased

(through such processes as breeding, mishandling during harvesting, storage or transportation) and

become harmful, these foods are then considered to be adulterated. This second and narrower part of

the statute is followed up in 406 of the FFDCA [8]:

406 Any poisonous or deleterious substance added to any food, except where such substance is required in

the production thereof or cannot be avoided by good manufacturing practice shall be deemed to be unsafe for

purposes of the application of clause (2) (A) of section 402(a); but when such substance is so required or

cannot be so avoided, the Secretary shall promulgate regulations limiting the quantity therein or thereon to

such extent as he finds necessary for the protection of public health, and any quantity exceeding the limits so

fixed shall also be deemed to be unsafe for purposes of the application of clause (2) (A) of section 402(a).

406 then, allows the FDA to establish tolerances for these unavoidable contaminants, that is, a

food may contain a toxin (such as mercury), if the presence of that toxin is (a) unavoidable and (b)

under the level tolerated, the food is not considered to be unsafe. Because establishing a tolerance

requires an extensive rule-making process, the FDA has adopted the use of action levels, which are

non-binding guidelines [9]. For food ingredients (e.g., additives), potentially harmful constituents or

contaminants are addressed by limiting the amount present in the specifications; higher than allowed

amounts render the ingredient and the food to which it has been added, adulterated.

A few potential foods are banned outright by regulation such as the slaughter of companion animals

(cats, dogs and horses) for food, offal and colostrum or those foods whose preparation is regulated by

guidelines other than current good manufacturing practices (e.g., pufferfish preparation). Some

naturally sourced substances (while present in some foods) are banned for addition to food for reasonsof safety and include safrole, calamus and coumarin (a full list of which may be seen in 21 Code of

Federal Regulations (CFR) 189). Other foods which may contain toxic substances, such as prussic acid

in peach leaves, -thujone in wormwood, saxitoxin in seafood, etc., are controlled by regulation

through the use of tolerances, or more correctly, specifications for the product that limit the amount of

toxin that may be present. For those foods or ingredients with potential for harm, but not addressed by

a specific regulation, action level, etc., the reference in the FFDCA to substances unfit for food and

flowing from that provision, Sections 402 and 406 of the FFDCA, apply. That is, the lack of a specific

action taken by the FDA (or any regulatory agency), for a potentially harmful substance is not a license

to market that substance.

3. Factors Driving the Acceptance of Certain Foods

Beyond the basic requirements of nutritional or hedonic value, the concept of exactly what

constitutes food is largely culturally based; that is, the consumption of pork, shellfish, eel, rocky

mountain oysters, cracklings, chitlins (chitterlings), brain, monkey, guinea pig, dog, snake, insects

and arachnids, etc., may be prohibited by religious practices or a matter of personal taste and, in the

case of brains (or neural tissue) at least from cattle, has recently become no longer acceptable.

Interestingly, there are no fruits or vegetables on any theocratic forbidden list.

There are some personal prohibitions that are genetically driven, but may not be perceived as a

toxicity concern.For example, a genetic variant has been described for cilantro, which is perceived


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by some people as having an unpleasant soapy taste or rank smell [10]. Another, better known variant

is the ability to taste phenylthiourea (also known as phenylthiocarbamide, PTU or PTC) [11]. The

ability to taste and smell certain substances may be key to evolutionary survival, as while the alkaloids

of many potentially poisonous plants confer a bitter flavor, Goff and Klee have indicated that certain

flavors and odors may also provide sensory cues for nutritional value of some plants [12]. For example,

the characteristic odor profile of tomato (e.g., tomato, green, or grassy) are derived from

cis-3-hexenal, cis-3-hexenol and trans-hexenal along with visual cues, to promote repeated

consumption of an enjoyable food. In the context of promoting consumption of a specific food anosmia

(lack of odor perception) or specific anosmia (which may be genetically based), will put the

individual at a competitive disadvantage in food selection. Persistent or total anosmia also represents a

clear safety hazard as the individual could not detect the tell-tale signs of decay or putrefaction of

unfit foods.

There are some food prohibitions that are medically driven, as the result of genetics or autoimmunedisease, as shown in Table 1.

Table 1.Medically driven food prohibitions (compiled from NORD [13]).

Disease/Syndrome Causative Food Cause Comment

Disaccharide

intolerance

Sucrose, dextrins Autosomal recessive trait characterized by

the deficiency or absence of enzymes sucrase

and isomaltase in the intestine.

Attacks characterized by bloating and

diarrhea.

Favism Broadbean (Vicia

fava)

X-linked recessive trait resulting in low

amounts of glucose-P-dehydrogenase.

Several subtypes known.

Hemolytic anemia may result from

consumption of offending foods.

Galactosemia Galactose and

lactose (dairy

products)

Autosomal recessive trait with low levels of

any one of three enzymes directly responsible

for galactose metabolism.

High levels of galactose in the blood

results in hepatomegaly, cirrhosis, and

renal failure. Infant mortality is ~75%.

Gluten intolerance Wheat, barley,

gluten containing

foods

Autoimmune disease Sensitivity to storage protein (gliadin) in

some grains.

Lactose intolerance Dairy products Inborn error of metabolismlow or no

lactase enzyme in the intestine.

Lactase is required to cleave lactose (a

disaccharide of galactose and glucose).

Bloating and diarrhea may develop.

Ornithine

transcarbamylase

deficiency

Dietary nitrogen

(primarily meat)

X-linked recessive disorder resulting in low

production of hepatic ornithine

transcarbamylase interrupting the urea cycle

and leading to accumulation of ammonia.

Although usually first seen in neonates,

there may be an adult onset.

Citrullinemia is another genetic disease

affecting the urea cycle.

Phenylketonuria

(PKU disease)

Phenylalanine in

foods

Autosomal recessive trait characterized by

inadequate hepatic phenylalanine

hydroxylase.

Leads to accumulation of phenylpyruvate

which may accumulate in the brain and

lead to seizures, mental retardation, etc.

Products containing phenylalaine must be

labeled.


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Table 1.Cont.

Refractory sprue Wheat, barley

and rye

Autoimmune disorder triggered by gliadin,

a gluten storage protein.

Unlike common celiac sprue, adherence to a

gluten-free diet may not cause symptoms to

abate.

Trimethylaminuria Fish Autosomal recessive resulting in low

production of flavin containing

monoxygenase enzyme 3 (FMO3).

Fish odor syndrome. Failure to breakdown

trimethylamine, a build of which results in a

fish odor.

Very long chain

Acyl CoA

dehydrogenase

deficiency (LCAD)

Very long chain

fatty acids

Autosomal recessive trait resulting from a

mutation in the HADHA gene.

Prevents mitochondrial metabolism of very

long chain fatty acids.

Other medically driven prohibitions include food allergies, the most common of which are to milk,

egg, fish, crustacean shellfish, tree nuts, wheat, peanuts and soybeans which account for 90% of all

food allergies in the US. The Food Allergen Labeling and Consumer Protection Act of 2004

(FALCPA), effective January 1, 2006, requires labeling of any product containing these ingredients or

a protein derived from one of these offending foods or incidental additives or flavors derived

therefrom. Exceptions are limited to any highly refined oil derived from a major food allergen

(e.g., peanut or soybean oil) or any food ingredient exempt from labeling under a petition or

notification processspecified in the law [14].

There are also a number of food-drug interactions, the consumption of one interfering with the

metabolism of the other, which may result in an enhanced or abated effect of the drug (Table 2).

Table 2. Food drug interactions (used with permission from Kotsonis and Burdock [15]).

Enzyme or

Transporter

Food Drug

CYP1A2 Caffeine, theophylline, grapefruit juice

(naringen and furanocourmarins bergmottin

and dihydroxybergamotin), grape juice,

cruciferous vegetables, apiaceous

vegetables, cooked meat

Clozapine, fluvoxamine,

imipramine

CYP2E1 Watercress and possibly other

isothiocyanate-containing cruciferous

vegetables; polyunsaturated fatty acids (corn

oil, menhaden oil)

Ethanol, halothane, enflurane

CYP3A4 Grapefruit, orange juice, red wine, possibly

other polyphenol-containing substances, St.

Johns wort, garlic

Ketoconazole, cyclosporine,

erythromycin, protease inhibitors,

HMG-CoA reductase inhibitors

UGT and GST Brussels sprouts, cabbage, watercress,

broccoli

Acetaminophen, oxazepam,

morphine, ibuprofen

P-glycopeptide and

OATP

Vegetables, fruit juice, St. Johns wort Digoxin, cyclosporine, parvastatin

UGT: uridine diphosphae glycuronosyltransferases; GST: glutathione-S-transferases; OATP: organic anion

transporting polypeptides.


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4. Toxin Incorporation during Growth, Storage or Processing

4.1. Environmental contaminants

4.1.1. Selenium in grain

Selenium (Se) enters the food chain via plant and microorganism conversion of inorganic selenium

to organically bound forms [16]. Selenium toxicity (i.e., selenosis), caused by excessive selenium

intake, has occurred on a large scale in seleniferous regions in China as the result of increased

consumption of selenium-containing foods (approximate daily intake of 36.5 mg Se/day) [17]. The most

common symptoms of selenosis are loss of hair, deformity, and loss of nails. Other reported symptoms

include increased blood selenium levels, diarrhea, fatigue, a garlic-like odor of the breath and bodily

secretions, irritability, peripheral neuropathy, and skin lesions [18]. Selenium intake levels that cause

selenosis have not yet been well defined. Studies in China suggest that approximately 35 mg/day(0.050.08 mg/kg/day) will cause selenosis. Residents of seleniferous regions in South Dakota who

consumed approximately 700 g selenium/day (0.01 mg/kg/day) showed no symptoms of selenosis.

The EPA has proposed an oral reference dose (RfD) of 0.005 mg/kg bw/day, or 350 g/day [19].

4.1.2. Methyl mercury in seafood

Exposure to elemental mercury is relatively rare, although was once an occupational disease of hat

manufacturers as elemental mercury was used for the curing of animal pelts. Inhalation of the mercury

fumes led to mental deterioration and subsequently named mad hatter syndrome [20].

Of interest to food toxicology, is the methyl derivative, methyl mercury, formed by bacterial action

in an aquatic environment from anthropogenic and natural sources of elemental mercury.

Anthropogenic sources include burning of coal (which contains mercury), chloralkali process and other

sources of elemental mercury into aquatic environments. In the case of Minamata, Japan, there was a

direct discharge of methyl mercury into the environment. Methyl mercury exposure may cause

neurological paresthesias, ataxia, dysarthria, hearing defects and death. Developmental delays have

been documented in children borne of mothers exposed to methyl mercury [21]. Other than direct

exposure to methyl mercury, exposure usually comes about as the result of methyl mercury becoming

incorporated into the food chain, moving up as each predator consumes the smaller and less fortunateanimal. Near the peak of the food chain, methyl mercury becomes concentrated in fish including,

bonito (Sarda spp.), halibut (Hippoglossus spp.), mackerel (Scomberomorus spp.), marlin

(Makaira spp.), shark (all species), swordfish (Xiphias gladius), and bluefin tuna (Thunnusspp.). The

selection of these species was based on historical data on levels of methyl mercury found in fish

consumed in the U.S. The selection was also based on an FDA action level of 1.0 ppm in the edible

portion of fish [22]. However, the allowable level of mercury depends on whether the mercury was

added; that is, did the presence of mercury arise from an anthropogenic source ( i.e., was the fish

caught in an area known for mercury discharge), or was not added and the result of mercury naturally

present in the environment [23].


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4.2. Naturally formed substances

4.2.1. -Thujone

Thujone, a monoterpene ketone, is the primary constituent of essential oils derived from a variety ofplants, including sage (Salvia officinalis), clary (Salvia sclarea), tansy (Tanacetum vulgare),

wormwood (Artemisia spp. and white cedar (Thuja occidentalis L.) [24]. Essential oils from these

plants are used in herbal medicines, as flavorings in alcoholic drinks and fragrances throughout the

world. Thujone is potentially toxic and the presence of alpha- or beta-thujone in food and beverages is

regulated by law in several countries. In the US, thujone as an isolated substance is banned as an

ingredient to be added to food and many of the natural thujone-containing plant oils (e.g., wormwood,

white cedar, oak moss (Evernia prunastri)and tansy) are used as flavorings in food under the condition

that the finished food is thujone-free [25].Absinthe (made from wormwood) contains significant levels

of thujone and is available in Spain, Denmark and Portugal. Wormwood itself is a popular flavoringfor vodka in Sweden, while vermouth, chartreuse, and Benedictine all contain small levels of thujone

[26]. Sage oil is used to provide the characteristic flavor in sausages, meats, condiments and sauces,

and contains approximately 2030% thujone (alpha- and beta-) [27,28]. Both alpha- and beta-thujone

act as noncompetitive blockers of the gamma-aminobutyric acid (GABA)-gated chloride channel [29].

The essential oils of sage, hyssop (Hyssopus officinalis L.), and cedar all contain thujone and have been

cited to have caused central nervous system effects characterized by tonic-clonic or solely clonic

convulsions [30]. Thujone is believed to be the toxic agent in absinthism, a syndrome produced by the

chronic use of absinthe, made from the essence of wormwood. The syndrome is characterized by

addiction, hyperexcitability and hallucinations. The debilitating illnesses suffered by Vincent Van

Gogh and Henri de Toulouse-Lautrec have been linked to absinthism, while the toxicity of thujone was

a major factor in banning absinthe in the early 1900s [31]. A published case report detailed a male

subject that drank about 10 mL of essential oil of wormwood (believing it was absinthe) and became

agitated, incoherent and disoriented, subsequently developing renal failure [32]. The no observable

effect limit (NOEL) for convulsions in subchronic toxicity studies in female rats was 5 mg/kg bw/day

[24]. Detoxification of thujone is thought to occur via CYP450-dependent oxidation and subsequent

glucuronidation and excretion [33]. The FDA limits exposure to -thujone fromArtemisia spp., when

used as a natural flavoring substance or natural substance used in conjunction with flavors

(21 CFR 182.20).

4.2.2. Prussic acid in cherry, apple and peach pits

Prussic acid (also known as hydrocyanic acid, hydrogen cyanide, or cyanide) is formed when

cyanogenic glycosides found in leaves, cherry, apple and peach pits, oak moss and other plant tissues

are damaged and come into contact with beta-glycosidase or emulsion enzymes. The enzymes release

the cyanide from the glycoside, and the cyanide prevents the bodys cells from utilizing oxygen,

resulting in cellular necrosis and tissue damage. The mucous membranes and blood are bright red as

they are oxygenated, but the cells in the tissues cannot utilize the oxygen. Clinical signs of prussic acid

poisoning include rapid breathing, trembling, incoordination and in extreme cases, respiratory and/or

cardiac arrest [34]. Many fruit trees contain prussic acid glycosides in the leaves and seeds, but only


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negligible levels are present in the fleshy parts of the fruit [35]. In the west African tropics, cassava is

consumed as a dietary staple and inappropriate handling of the cassava prior to processing and

consumption can result in a chronic form of cyanide poisoning termed tropical ataxic neuropathy, the

result of demyelinization of the optic, auditory, and peripheral nerve tracts [36].

Prussic acid as found in flavoring ingredients is limited to 25 ppm in cherry pits (Prunus avium L.

orP. cerasus L.), cherry laurel leaves (Prunus laurocerasus L.), elder tree leaves (Sambucus nigraL.),

and peach leaves (Prunus persica (L.) Batsch) (21 CFR 172.510); although the extract of bitter almond

(Prunus amygdalusBatsch,Prunus armeniacaL., orPrunus persica(L.) Batsch) must be prussic acid

free (21 CFR 182.20). There are no FDA regulations or guidelines restricting the presence of prussic

acid in apple seed (Malusspp.), probably because extracts of these seeds have no economic value as

flavor ingredients.

4.2.3. Hypericin in St. Johns wort

St. Johns wort (Hypericum perforatum; Figure 1) is an herbal thought to alleviate symptoms of

depression, and standardized extracts of St. Johns wort are consumed typically in tablet or capsule

form. The major active antidepressive constituents in St. Johns wort are thought to be hyperforin and

hypericin [37,38]. The mechanism of action is not fully understood, but may involve inhibition of

serotonin (5-HT) reuptake, similar to conventional antidepressive drugs. In this manner, hyperforin and

hypericin taken in conjunction with other serotonin reuptake inhibitors may contribute to

serotonin syndrome, a potentially life-threatening elevation of serotonin in the central nervous system.

Hyperforin is also known to induce cytochrome P450 enzymes CYP3A4 and CYP2C9, which can lead

to increased metabolism of certain drugs and decreased clinical response [39].

Figure 1.St. Johns wort (Hypericum perforatum) [40].

In large doses, St. Johns wort is poisonous to grazing animals, with published cases of livestock

poisoning characterized by general restlessness and skin irritation, hindlimb weakness, panting,confusion, depression and in some instances, mania and hyperactivity resulting in the animal running

in circles until exhausted [41]. In humans, consumption of St. Johns wort may result in


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photosensitization, and at high continuous doses, some liver damage may occur [39]. The FDA limits

exposure to St. Johns wort (Hypericum perforatum), including the leaves, flowers, and caulis, by

mandating that only hypericin-free alcohol distillate form may be used and then, only in alcoholic

beverages (21 CFR 172.510).

4.2.4. Goitrogens (glucosinolates) inBrassicaspp.

Certain raw foods have been found to contain substances that suppress the function of the thyroid

gland by interfering with the uptake of iodine, an essential nutrient in growth, cognitive function, and

hormonal balance. A lack of functional iodine is known to result in cognitive deficiencies

(e.g., Cretinism). The decrease in iodine uptake causes the thyroid gland to enlarge, forming a goiter.

Foods that have been identified as goitrogenic include spinach, cassava, peanuts, soybeans,

strawberries, sweet potatoes, peaches, pears, and vegetables in the Brassica genus, which include

broccoli, brussels sprouts, cabbage, canola, cauliflower, mustard greens, radishes, and rapeseed [42].Goiter has also been attributed to the consumption of large quantities of uncooked kale or cabbage.

High temperatures (i.e., cooking) inactivate the goitrogenic substances, collectively termed

glucosinolates. Cassava (Manihot esculenta)is an essential dietary source of energy in the tropics, but

contains high levels of linamarin, a glucosinolate. Cassava must be properly processed-dried, soaked in

water or baked to effectively reduce the linamarin content [43]. Glucosinolates are sulfur-containing

substances that are metabolized in the body by thioglucosidase to form thiocyanate, isothiocyanate,

nitriles and sulfur. Under certain conditions the isothiocyanates undergo cyclization to form goitrins,

increasing their potent goitrogenic activity. The oils from rapeseed (Brassica napus)must be analyzed

for potential goitrins to circumvent potential goitrogenic activity when consuming these oils [44]. No

FDA regulations were located for permissible concentrations of glucosinolates in human food.

Glucosinolates (calculated as epi-progoitrin) and goitrin are limited to not more than 4% and 0.1%

(respectively) of the seed meal of Crambe abyssinica(Crambe meal) obtained after the removal of the

oil and used as an animal feed ingredient (21 CFR 573.310).

4.2.5. Erucic acid in rape

Rape (BrassicanapusL. orBrassica campestrisL.) is an annual herb of the mustard family native

to Europe and is grown in the United States because it produces oil-rich seeds for cooking oil [45].Rapeseed oil had been used for hundreds of years as oil for lamps and more recently as machine oil

lubricant. Widespread use of rapeseed oil as a food ingredient was not considered until the late 1940s

and 50s. However, early studies found that feeding high levels of rapeseed oil to rats significantly

increased cholesterol levels in the adrenal glands and lipidosis in the cardiac tissue [46,47]. This effect

was also noted in chickens, ducks and turkeys fed high levels of rapeseed oil, resulting in growth

retardation, mortality, and a thickening of the epicardium and increased fibrous tissue in different areas

of the myocardium [48]. Erucic acid was identified as the causative agent of these effects of rapeseed

oil. Erucic acid is a long-chain fatty acid with one unsaturated carbon-carbon bond (C22:1). High

levels of erucic acid have been liked to fatty deposit formation in heart muscle in animals [49]. Erucic

acid is poorly oxidized by the mitochondrial -oxidation system, especially by the myocardial cells,

which results in an accumulation of erucic acid, producing myocardial lipidosis which has been


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reported to reduce the contractile force of the heart [50]. Although myocardial lipidosis due to erucic

acid consumption has not been confirmed in humans, animal feeding studies confirmed the formation

of myocardial lipidosis in a variety of animal species in a dose-dependent manner, which has been the

standard assessment by government agencies of potential adverse effects in humans. Canola oil is

obtained from Canola (Canadian oil, low acid), a rapeseed variety that was conventionally bred in the

late 1970s in Canada to contain reduced levels of erucic acid and glucosinolates [51,52]. The FDA

limits the amount of erucic acid in Canola oil to no more than 2% of the component fatty acids

(21 CFR 184.1555).

4.2.6. Furocoumarins

Furocoumarins represent a family of natural food constituents with phototoxic and photomutagenic

properties. They are found mainly in plants belonging to the Rutaceae (e.g., citrus fruits) and

Umbelliferae (e.g., parsnip, parsley, celery, carrots) families. Furocoumarins are produced in responseto stress, to aid plants in defense against viruses, bacteria, fungi, insects and animals, and are regarded

as natural pesticides [53]. Concentrations may also increase after exposure to UV radiation, changes in

temperature, prolonged storage, or treatment with hypochlorite or copper sulfate (Chaudhary et al., as

cited in Wagstaff 1991 [53], p. 270 and Beier et al., as cited in Ashwood-Smith [54], p. 916).

The three most active furocoumarins in producing photodermatitis are psoralen, 5-methoxypsoralen

(5-MOP, bergapten), and 8-methoxypsoralen (8-MOP, xanthotoxin or methoxsalen) [55]. In the

presence of near UV light (320380 nm), these three linear furocoumarins can form adducts with DNA

and DNA-crosslinks. The consequences of these photoadditions to cells are cell death, mutations and

chromosome aberrations [54]. In the presence of ultraviolet A radiation, 5-MOP and 8-MOP produce

skin tumors in experimental animals. At a chronic dose of 37.5 mg/kg bw/day in the diet, 8-MOP

produces increased incidences of tubular cell hyperplasia, adenomas, and adenocarcinomas of the kidney

and carcinomas of the Zymbal gland in rats [56]. Cases of skin cancer have been reported in patients

treated with 8-MOP and long-wave ultraviolet light for treatment of psoriasis or mycosis fungoides

[57,58]. IARC has classified 5-MOP and 8-MOP plus ultraviolet radiation in group A (probably

carcinogenic in humans) and in group 1 (carcinogenic to humans), respectively [57,59].

Citrus fruits, especially grapefruit, produce a variety of chemicals in their peels that may have

adverse interactions with drugs. Typically, citrus fruit juice is produced utilizing the whole fruit,

including the peel. One chemical found in the peel is bergamottin (also known as bergamot), a natural

furanocoumarin that is known to inhibit some isoforms of the cytochrome P450 enzyme (CYP) 3A4

[60]. Inhibition of this enzyme prevents oxidative metabolism of certain drugs, resulting in an elevated

concentration of a drug in the bloodstream [61]. Bergamot and other chemicals in citrus (e.g., lime,

grapefruit, orange, lemon) oils [62] are also phototoxic, causing significant toxicity to the skin when

exposed to sunlight [63]. 5-Methoxypsoralen, the most phototoxic constituent of bergamot oil, showed

mutagenic activity in bacterial assays and clastogenic effects in mammalian cells in culture when

exposed to UV light [64].

Celery reportedly contains 100 ppb psoralens (100 micrograms/kg) and parsnips as much as 40 ppm(40 mg/kg) [65]. The estimated dietary intake of furocoumarins for people eating furocoumarin-containing

foods (est. 80% of the population) is 1.31 mg/day [53], which is approximately 0.022 mg/kg bw/day


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for a 60 kg human. This is approximately 1000-fold lower than the 13-week dietary no observable

adverse effect level (NOAEL) for liver toxicity in the rat (25 mg 8-MOP/kg bw/day) and 1700-fold

lower than the dietary dose that has been shown to induce cancer in rats (37.5 mg/kg). Therefore, the

risk of developing liver toxicity or cancer due to ingestion of psoralens in the diet is low.

In humans, the phototoxic threshold dose of furocoumarin mixtures after dietary exposure is of the

order of 10 mg 8-MOP plus 10 mg 5-MOP, which is equivalent to about 15 mg 8-MOP per person.

This phototoxic threshold dose is not reached by the consumption of celery roots and other

conventional vegetables under normal dietary habits, which result in intake of approximately 28 mg

furocoumarins per person [66]. Therefore, ordinarily dietary exposure to psoralens is not considered to

be a significant risk for development of photodermatitis, albeit the margin of safety is low [65]. There

are no FDA regulations or guidelines specific to the presence of furocoumarins in food.

4.2.7. Amylase inhibitors

Naturally occurring inhibitors of -amylase are found in aqueous extracts of wheat, rye and kidney

beans. The physiological role of -amylase inhibitors in plants is not well understood, but may protect

them against insect infestation. In mammals, some amylase inhibitors have been shown to attenuate the

normal increase in blood glucose that occurs after ingestion of starch. However, since -amylase

inhibitors have been shown to be inactivated by gastric acid, pepsin or pancreatic proteinases, their

potential as starch blockers is limited [67]. -Amylase inhibitors were once added to foods as starch

blockers to limit carbohydrate absorption for the purpose of weight loss; however, the FDA later

determined that at least this use of -amylase inhibitors was as drug, and they were consequently taken

off the market [68].

-Amylase inhibitor protein is a major allergen (referred to as Asp o 2) that has been implicated in

the development of occupational toxicity known as bakersasthma disease [69]. Although -amylase

inhibitor protein is naturally found in wheat flour, it is also found in flour in which -amylase from

Aspergillus oryzaehas been added to enhance carbohydrate fermentation by yeast [70]. Consequently,

-amylase inhibitor protein can be potentially found in baked products that are derived from sources

other than wheat. Cases of food allergy have been reported in people ingesting bread containing

-amylase inhibitor protein. Symptoms of allergy include sneezing, rhinorrhea, oropharyngeal itching,

hoarseness, cough and dyspnea [71].

High -amylase inhibitor activity against human salivary -amylase has been found in wheat flour

(590 units/g), whole wheat flour (351 units/g) and whole rye flour (186 units/g). Bread baking reduces

the activity by 80100%, depending on type. The activity in uncooked spaghetti (248 units/g) is

reduced more than 98% by 15 minutes of boiling. Boiling of red beans for 1.5 hours reduces activity to

undetectable levels [71]. However, -amylase has been shown to retain some allergenic activity when

heated to 200 C (Baur et al., as cited in Phadia AB 2010 [72], p. 2).

4.2.8. Lectins in legumes

Lectins are a group of glycoproteins that are present in high levels in legumes (e.g., black beans,

soybeans, lima beans, kidney beans and lentils) and grain products [73,74]. Lectins can reversibly bind

to carbohydrates without altering their covalent structure [73]. The ability of lectins to bind to and


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agglutinate red blood cells is well known and used for blood typinghence the lectins are commonly

called hemagglutinins. Lectins also can bind avidly to mucosal cells and interfere with nutrient

absorption from the intestine [75]. Because the ability of the lectins to cause intestinal malabsorption is

dependent on the presence of enteric bacteria, it has been hypothesized that lectins may also produce

toxicity by facilitating bacterial growth in the GI tract [76].

Lectins isolated from black beans can produce growth retardation when fed to rats at 0.5% of the

diet, and lectin from kidney beans causes death within two weeks when fed to rats at 0.5% of the diet.

Soybean lectin produces growth retardation when fed to rats at 1% of the diet. The castor bean lectin

ricin (one of the most toxic natural substances known) is notorious for causing deaths of children, and

has been used as an instrument of bioterrorism [75].

Phytohaemagglutinin (PHA) is a lectin found in significant quantities (as much as 2.45% of total

protein) in legumes such as red or white kidney beans, green beans and fava beans. PHA has a number

of different properties, including the ability to induce mitosis, affect membrane transport andpermeability to proteins, and agglutinate red blood cells. Rats fed a diet containing 6% PHA exhibit

weight loss, associated with malabsorption of lipid, nitrogen and vitamin B12 [76]. PHA from red

kidney beans inhibits sodium and chloride absorption in the rabbit ileum, indicating that PHA can

affect electrolyte transport in the gut [77]. Symptoms of toxicity to PHA in humans such as nausea,

vomiting, or diarrhea occur within three hours of ingestion. Recovery generally occurs within four or

five hours of onset [78].

There are no FDA regulations or guidelines restricting the presence of lectins in food, but the FDA

does provide recommended cooking practices prior to consuming legumes. Concentrations of PHA

(and other lectins) are higher in uncooked than cooked beans. A raw, red kidney bean can contain up to70,000 hemagluttinating units (hau). Most lectins are reduced by moist, but not dry heat. Therefore,

steaming or boiling causes a significant reduction in concentrations of lectins in beans. Boiling for at

least ten minutes has been shown to reduce hau in beans by 200-fold. Because cooking temperatures

under 176 F do not destroy lectin, use of slow cooking and/or a crockpot is not advised for cooking

beans [79].

4.2.9. Anti-thiamine compounds

Substances that act on the availability of vitamins are commonly referred to as antivitamins. These

include materials that can cause a deficiency of vitamins by competing with vitamins in various

metabolic reactions as the result of similar chemical structure or destroying or decreasing the effects of

a vitamin by modifying the molecular conformation or by forming a complex [67].

Thiaminase cleaves thiamine (vitamin B1) at the methylene linkage, rendering it biologically

inactive. Activity of thiaminase requires a cosubstrateusually an amine or sulfhydryl-containing

protein such as proline or cysteine. Thiaminase is found in fish, crab, clams and in some fruits and

vegetables such as blueberries, black currants, red beets, Brussels sprouts and red cabbage [67].

Thiamine is an essential vitamin involved in energy production. Thiamine deficiency is associated

with impaired pyruvate utilization, resulting in a shortage of cellular ATP. In humans, thiaminedeficiency may lead to weakness and weight loss. Severe thiamine deficiency produces beri-beri, a

disease characterized by anorexia, cardiac enlargement, and muscular weakness leading to ataxia [80].


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Cooking destroys thiaminases in fish and other sources. There are no FDA regulations or guidelines

specific to the presence of thiaminase in food.

4.2.10. Pyrrolizidine alkaloids

Pyrrolizidine alkaloids (PAs) are found in some plants of the Apocyanacae, Asteraceae,

Boraginaceae, Compositae (Senecionae and Eupatoriae), Fabaceae, Leguminosae (Crotalaria),

Rannuculaceae and Scrophulariaceae families. Herbs such as comfrey root and leaf (Symphytum spp.)

(Figure 2), coltsfoot leaf and flower (Tussilago farfara) and borage leaf (Borago officinale), and

several species of Eupatorium typically contain high levels of PAs. Humans are exposed to PAs

through the accidental contamination of foodstuffs and intentional ingestion of PA-containing

vegetables and herbal medicines. Serious incidences of illness have been reported in people consuming

cereal grains that are contaminated with the seeds of PA-containing plants [81]. PAs are also present in

milk from cows and goats and in honey [82].

Figure 2.Comfrey (Symphytum officianaleL.) [83].

The pyrrolizidine structure is based on two fused, five-membered rings that share a bridgehead

nitrogen atom, forming a tertiary alkaloid. The rings contain a hydroxymethylene group at the C-1position and a hydroxyl group at the C-7 position, forming a necine base. Several PAs that contain

unsaturated necine rings are hepatotoxic, mutagenic, teratogenic and/or carcinogenic. Toxicity is

thought to be due to enzymatic conversion of PAs to pyrroles, which act as alkylating agents [67].

Pyrroles formed in the liver can travel to the lungs, causing thickening of the pulmonary vasculature

and pulmonary hypertension [82].

The sale of comfrey products for internal use has been banned in the United States and Canada [82].

However, comfrey tea is still widely available. It is estimated that consumers of comfrey tea could be

ingesting up to 5 mg of PAs per day (Speijers and Egmond, as cited in Deshpande 2002b [81], p. 368),

or 0.083 mg/kg bw/day. The range of toxic doses in humans is thought to be 0.110 mg/kg per day

[84], although the World Health Organization has reported a case of veno-occlusive disease in a

subject ingesting 0.015 mg PAs/kg of body weight per day from comfrey.


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4.2.11. Rhubarb and oxalic acid

Oxalic acid (oxalate) is generally found in rhubarb (0.21.3%), tea (0.32.0%), spinach (0.31.3%),

parsley (1.7%) and purslane (1.3%), but may also be found in asparagus, broccoli, Brussels sprouts,

collards, lettuce, celery, cabbage, cauliflower, turnips, beets, peas, coffee, cocoa, beans, potatoes,berries, and carrots [67,73,85].

Oxalic acid is an organic acid that can bind calcium and other minerals, making them insoluble and

decreasing their bioavailability. Ingestion of foods containing high concentrations of oxalates may

cause decreased bone growth, kidney stones, renal toxicity, vomiting, diarrhea, convulsions, coma and

impaired blood clotting [73]. The significant role oxalate plays in kidney stone development is

exemplified by the fact that approximately 65% of kidney stones consist of calcium oxalate [86].

Using the oral LD50 value of 375 mg/kg in rats, it has been estimated that ingestion of

approximately 22 g of oxalic acid could be lethal to a 59 kg human [85]. Because approximately 4.5 kg

of rhubarb leaves would have to be ingested in order to achieve a lethal dose, it has been hypothesized

that documented cases of fatal rhubarb poisoning in humans were due to consumption of some other

substance than oxalic acid [67].

Because cooking does not remove oxalate, and mineral complexes with oxalate are insoluble in

water, oxalates are somewhat difficult to remove from foods. Therefore, diets rich in oxalate-containing

foods should be supplemented with minerals such as calcium or potassium to prevent deficiencies.

Limits on oxalic acid have been cited in ferric ammonium ferrocyanide and ferric ferrocyanide when

used as color additives (21 CFR 73.1298 and 21 CFR 73.1299) with oxalic acid or its salts at not more

than 0.1% of the colorant.

4.2.12. Zucchini and cucurbitacins

Members of the Cucurbitaceafamily (zucchini, cucumbers, pumpkins, squash, melons and gourds)

produce cucurbitacins (oxygenated tetracyclic terpenes) that act as movement arresters and compulsive

feeding stimulants for Diabriticine beetles (corn rootworms and cucumber beetles). Cucurbitacins are

among the most bitter compounds known, and in nanogram quantities they deter most non-Diabrotic

herbivores [87].

Because cucurbitacins act as feeding stimulants, they are added to insecticidal baits to increase

efficacy [88]. Therefore, dietary exposure to cucurbitacins could occur through ingesting plants that

normally contain them or by ingesting plants to which cucurbitacin-containing pesticides have

been applied.

Under normal circumstances, cucubitacins are produced at low enough concentrations that are not

perceived as being bitter by humans. In response to stresses such as high temperatures, drought, low

soil fertility and low soil pH, concentrations in fruits such as cucumbers may increase and cause the

fruits to have a bitter taste [89]. Occasional cases of stomach cramps and diarrhea have occurred in

people ingesting bitter zucchini. Twentytwo cases of human poisoning from ingestion of as little as

3 grams of bitter zucchini were reported in Australia from 1981 to 1982, and in Alabama and

California in 1984. The cultivar implicated in the Australia poisonings was Blackjack [90]. There are

no FDA regulations or guidelines specific to the presence of cucurbitacins in food.


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4.2.13. Coumarins (tonka bean, woodruff, clover)

Coumarin (2H-1-benzopyran-2-one) is found in herb teas made from tonka beans (Dipteryx odorata),

melilot (Melilotus officinalisorMelilotus arvensis) and woodruff (Asperula odorata), the flavoring oil

of bergamot (from Citrus bergamia) and the spice cassia (Cinnamomum cassia; sometimes sold ascinnamon) [91]. Coumarin is liberated from the glycoside melilotoside (an ether of glucose bonded

with an ester bond to coumarin) on drying coumarin-containing herb material.

Molds present in spoiled sweet (Melilotus) clover and other hay products can metabolize coumarin

to dicoumarol, which is similar in structure to vitamin K [92]. Vitamin K is necessary to activate

prothrombin, which is converted to the blood clotting substance thrombin. By inhibiting vitamin K,

dicoumarol promotes bleeding. Concentrations of dicoumarol in fodder >10 ppm have been

responsible for fatalities by hemorrhaging in cattle [91].

The addition of coumarin to food in the United States was banned in 1954, based on reports of

hepatoxicity in rats. However, because a number of foods contain coumarin, humans ingest

approximately 0.02 mg coumarin/kg bw/day. The chronic administration of high doses of coumarin

causes liver tumors in the rat and liver and lung tumors in the mouse. Overall, available data indicate

that coumarin is not genotoxic. It is thought that the carcinogenicity of coumarin is caused by

metabolism to toxic epoxides. Because doses of coumarin that cause toxicity and carcinogenicity in the

lung and liver of experimental animals are more than 100 times the maximum human intake, exposure

to coumarin from food poses no health risk to humans [93].

The addition of coumarin is prohibited in 21 CFR 189.130. The regulation notes that coumarin is

found in tonka beans and extract of tonka beans, among other natural sources, and is also synthesized.It has been used as a flavoring compound, therefore addressing not just natural products (which would

include buffalo grass or sweetgrass (Hierochloe odorata) used in flavoring vodka and other natural

sources (see above)), as well as synthesized coumarin. Further, according to the regulation, (b) Food

containing any added coumarin as such or as a constituent of tonka beans or tonka extract is deemed to

be adulterated under the act, based upon an order published in the Federal Register of March 5, 1954

(19 Federal Register 1239).An analytical method for detection of coumarin in foods is specified in

21 CFR 189.130.

4.2.14. Phytates and phytic acid

Phytic acid (also referred to as phytate) is found in bran and germ of many plant seeds and in grains,

legumes and nuts. Phytic acid is a simple sugar (myo-inositol) containing six phosphate sidechains, and

as such, is a dietary source of phosphorus and an effective chelator of divalent cations such as zinc,

copper, iron, magnesium and calcium [67,94]. Studies indicate that phytate-mineral complexes are

insoluble in the intestinal tract, reducing mineral bioavailability [73]. Phytate also has been shown to

inhibit digestive enzymes such as trypsin,pepsin, -amylase and -glucosidase. Therefore, ingestion of

foods containing high amounts of phytate could theoretically cause mineral deficiencies or decreased

protein and starch digestibility. Vegetarians that consume large amounts of tofu and bean curd are

particularly at risk of mineral deficiencies due to phytate consumption.


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Because phytate-rich foods are digested at a slower rate and produce lower blood glucose responses

than foods that do not contain phytate, it has been hypothesized that phytate could have a therapeutic

role in management of diabetes [67]. It also may have utility as an antioxidant [95]. However, because

the beneficial effects of phytate are outweighed by its ability to cause essential mineral deficiencies,

consumption of a diet containing high amounts of phytate is not recommended. Food manufacturers are

developing methods to reduce phytate in foods, such as addition of the microbial phytase, which

releases phosphates from the inositol backbone of phytate [96].

Phytate is fairly heat stable, but can be removed by soaking or fermentation [67]. The soybean has

one of the highest phytate levels of any grain or legume, and requires a long period of fermentation for

reduction [94]. In people who consume large amounts of soy products, mineral deficiencies can be

prevented by consumption of meat or dairy products or use of supplemental vitamins. There are no

FDA regulations or guidelines restricting the presence of phytates in food.

4.2.15. Hypoglycin in Ackee

Ackee (Blighia sapida; Figure 3) is the national fruit of Jamaica and is also found in other

Caribbean nations, Central America, South American and southern Florida [97]. Consumers of the

unripe fruit sometimes suffer from Jamaican vomiting sickness syndrome allegedly caused by the

alkaloids hypoglycin A (HGA) and B. Levels of HGA in the opened, ripe fruit are undetectable,

making opened fruit safe for consumption [98].

The hypoglycin toxin (L-methylenecyclopropylalanine) inactivates several flavoprotein acyl-CoA

dehydrogenases, causing disturbances of the oxidation of fatty acids and amino acids [99]. This leads

to a secondary inhibition of gluconeogenesis which can precipitate an extreme, dangerous drop in

blood-glucose levels (hypoglycemia) that can be fatal. Symptoms of poisoning from unripe ackee fruit

occur within 6 to 48 hours of ingestion and include drowsiness, repeated vomiting, thirst, delirium,

fever or loose bowels. Exhaustion of the muscular and nervous systems, collapse, coma, and death may

ensue [100,101].

Figure 3.Unripe Ackee Fruit (left panel) and ripe Ackee Fruit (right panel) [100].

Dietary exposure to hypoglycin in Jamaicans ranges from 1.2189.28 micrograms/gram

ackee [102]. Ingestion of one 100 gram fruit could therefore result in a dose of approximately

300 micrograms/kg bw in a 30 kg child. This dose is approximately one-fifth of the maximum tolerated

dose of HGA in male and female rats of 1500 micrograms/kg bw/day [103], indicating that normal use

levels of ackee do not have a large margin of safety.


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The importation of canned ackee fruit into the United States is restricted to certain manufacturers to

insure that only properly ripened ackees are used for canning [104], and the FDA routinely analyzes

incoming shipments of ackee for hypoglycin levels that could be a health concern, having issued a

recall of canned ackee fruit for this very reason in 2005. If hypoglycin poisoning is expected, glucose,

fluids and electrolytes should be administered. Antiemetics may be used to control vomiting and

benzodiazepines to control seizures. Endotracheal intubation should be performed in people exhibiting

seizures or coma [97].

4.2.16. Safrole

Safrole (1-allyl-3,4-methylenedioxybenzene) is found in aromatic oils of nutmeg (Myristica fragrans),

cinnamon (Cinnamomum verum) and camphor (Cinnamomum camphora) and is a major constituent of

oil of sassafras (Sassafras albidum) [105]. Prior to being banned as a food additive in the United States

in 1960, safrole was commonly used to flavor root beer and other foods. Most commercial sassafrasteas and root beers are now artificially flavored as a result of the FDA ban(21 CFR 189.180).

At a concentration of 1% in the diet, safrole produces weight loss, testicular atrophy, bone marrow

depletion and malignant liver tumors in rats [106]. Based on sufficient evidence of carcinogenicity in

experimental animals, safrole is reasonably anticipated to be a human carcinogen [107]. The

mechanism of carcinogenicity is thought to involve cytochrome P450 catalyzed hydroxylation of

safrole to 1-hydroxysafrole, and its subsequent metabolism to highly reactive electrophiles that bind to

DNA [108].

Despite the FDA ban, sassafras is still a popular ingredient in herb teas and preparations [73]. The

hazardous dose of sassafras oil for humans (which typically contains 80% safrole) is considered to be

0.66 mg/kg [109]. This may be exceeded by ingesting sassafras tea, which has been estimated by

Segelman and Bisset (as cited in Burfield 2009 [109], p. 3) to give a dose of 3 mg/kg for a

60 kg individual.

4.2.17. Myristicin

Myristicin (Figure 4) is a naturally occurring insecticide and acaracide that is found in nutmeg and

mace (Myristica spp.)at concentrations of 1.3% and 2.7%, respectively [110]. It is also present in black

pepper, carrot, celery parsley and dill [67]. It is estimated that the average total intake of myristicinfrom dietary sources is in the order of a few mg per person per day[110].

Figure 4.Structure of myristicin.

Myristicin is a weak inhibitor of monoamine oxidase, and is structurally related to mescaline. At a

dose level of 67 mg/kg bw, it may cause psychotropic effects in man, such as increased alertness, and


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a feeling of irresponsibility, freedom and euphoria. Unpleasant symptoms, such as nausea, tremor,

tachycardia, anxiety and fear have also been reported in humans ingesting this dose. Although the

metabolism of myristicin resembles that of safrole, there is no evidence to suggest that myristicin is

carcinogenic [110]. There are no FDA regulations or guidelines specific to the presence of myristicin

in food.

At the concentrations normally present in spices or food, the likelihood of toxicity arising from

myristicin is low. However, ingestion of greater than 5 grams of nutmeg (corresponding to 12 mg/kg bw

myristicin) has produced toxicological symptoms in humans that are similar to alcohol intoxication.

Because the myristicin content of nutmeg is approximately 13%, it is likely that components of

nutmeg in addition to myristicin contribute to nutmeg toxicity [110].

4.2.18. Tomatine in tomatoes

The leaves, stems and unripe fruit of the tomato plant contain -tomatine, a steroidal alkaloidcontaining D-xylose, D-galactose, and two molecules of D-glucose. Tomatine is toxic to a number of

different fungi, thereby acting as a natural fungicide. It has been hypothesized that the toxic effects of

tomatine on fungi are due to the ability of tomatine to complex with membrane sterols, causing

membrane disruption [111].

Currently, there is no evidence to suggest that tomatine is a substance of concern. There are no

reports of acute toxicity in humans due to ingestion of green tomatoes and there are no FDA

regulations or guidelines specific to the presence of tomatine in food. Ingestion of a rare variety of ripe

tomato (Lycopersicon esculentumvar. cerasiforme) that contains up to 5 mg tomatine/g of dry weight

has no adverse effects on natives who commonly ingest them [112].

Concentrations of tomatine decrease as tomatoes ripen, and ripe fruit contains approximately 36 mg

per a 100 gram tomato [73]. Microwaving or frying does not reduce content of tomatine, and

delayed-ripening varieties of tomatoes contain similar concentrations of tomatine as other

tomatoes [113]. At this time, there is no evidence to suggest that a diet high in green tomatoes would

be injurious to human health. Tomatine forms strong, insoluble complexes with cholesterol in vitro,

and has been shown to lower plasma LDL cholesterol in hamsters [114], suggesting that it may have

beneficial effects on blood lipids of humans.

4.2.19. Japanese star anise

Chinese star anise (Illicium verum) is a common source of anethole, a popular flavoring ingredient.

On the other hand, Japanese star anise (Illicium anisatum) is scientifically recognized as highly

poisonous and not fit for human consumption. Japanese star anise contains the potent neurotoxins

anisatin and neoanisatin, as well as the neurotoxic sesquiterpene lactone veranisatins that are normally

found in other kinds of star anise, including Chinese star anise [115].

Brewed teas containing star anise have been associated with illnesses affecting about

40 individuals, including approximately 15 infants. The illnesses ranged from serious neurological

effects, such as seizures, to vomiting, jitteriness and rapid eye movement. Due to the potential for

adulteration, on September 10, 2003, the FDA issued an advisory to the public not to consume teas


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brewed from star anise, until the FDA is able to differentiate between the Japanese star anise and

Chinese star anise, which does not contain anisatin [116].

4.3. Substances formed as the result of product abuse

4.3.1. Glycoalkaloids (solanine and chaconine) in potatoes

The glycoalkaloids -solanine and -chaconine are natural pesticides that are produced in potatoes.

-Solanine is also found in eggplant, apples, bell peppers, cherries, sugar beets and tomatoes [74,117].

The only difference between -solanine and -chaconine is the sugars in the trisaccharide potion of the

molecule, i.e., glucose with two rhamnoses for -solanine and a glucose, galactose and a rhamnose for

-chaconine [118].

Depending on variety and storage conditions, concentrations of -chaconine and -solanine in

potato tubers vary between 0.5635 ppm (0.00050.64 mg/g potato) and 5125,100 molecule ppm(0.00525.1 mg/g potato), respectively (Beckstrom-Sternberg, as cited in Tice 1998 [117], p. 9).

Although glycoalkaloids are found throughout the potato tuber, the greatest concentrations are in the

sprouts, peels and sun-greened areas [74]. The FDA considers the maximum acceptable glycoalkaloid

content to be 2025 mg/100 g fresh potato weight (or 200250 ppm) (Crocco, as cited in FDA

2008 [119], p.1). Under current FDA regulations, 20 milligrams of solanine per 100 grams (a small

potato) can render it unfit to eat.

Synthesis of -chaconine and -solanine is stimulated by light, mechanical injury, aging and potato

beetle infestation [117,120]. Exposure of potatoes to light in the field or marketplace can lead to

glycoalkaloid concentrations that are unsafe for human consumption. Concentrations of solanine ingreen or blighted potatoes have been shown to increase by seven fold [73].

The symptoms of acute toxicity to -solanine and -chaconine are due to their ability to act as

inhibitors of acetylcholinesterase and disruptors of cell membranes. Glycoalkaloid doses of 1 to 5 mg/kg

have been shown to be acutely toxic to humans, and doses of 3 to 6 mg/kg have resulted in

death [117]. Symptoms of glycoalkaloid toxicity in humans include drowsiness, itchiness in the neck

region, increased sensitivity (hyperesthesia), labored breathing and gastrointestinal symptoms

(abdominal pain, nausea, vomiting and diarrhea) [74].

-Solanine and -chaconine are not mutagenic or only weakly mutagenic in vitro, are not genotoxic

in vivo, and are embryotoxic and teratogenic to experimental animals. Teratogenic effects in mammals

include central nervous system abnormalities (e.g., exencephaly, cranial bleb, encephalocele, and

anophthalmia), mild hydronephrosis, hydroureter, and irregular or fused ribs. Although one human case

study reported a correlation between the severity of potato late-blight and the incidence of spina bifida,

no other studies in humans have found a correlation between the consumption of potatoes and birth

defects [117]. There is no evidence that -solanine and -chaconine are carcinogenic in animals

or humans.

In 1993, the National Institute of Environmental Health Sciences determined that the average

consumption of glycoalkaloids from potatoes was 12.75 mg glycoalkaloids/person/day (0.18 mg/kg bw

based on a bw of 70 kg) [117], which is approximately one-fifth of the lowest dose that has been

shown to produce acute toxicity in humans (1 mg/kg bw).


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4.3.2. Furocoumarin in parsnips

Ceska et al. reported that older 'spoiled' and diseased parsnips freely available in grocery stores may

contain furocoumarin concentrations 2500% higher than fresh parsnips [121]. Microbial infection of

parsnip roots can result in a dramatic increase in furocoumarin levels. Furocoumarin concentrations(the sum of five furocoumarins: angelicin, isopimpinellin, 5-MOP, 8-MOP and psoralen) in freshly

harvested parsnips are generally lower than 2.5 mg/kg and do not increase after storage at 18 C for

up to 50 days. In contrast, storage of whole parsnips (but not cubes or homogenate) at 4 C resulted in

a marked biphasic increase of furocoumarin concentrations (to approximately 40 mg/kg) after seven or

38 days of storage. A dramatic increase in furocoumarin concentrations (up to 566 mg/kg) was

observed when whole parsnips were kept at room temperature over 53 days, resulting in a visible

microbial (mold) infection [122].

In celery, infection with fungal pathogens has been shown to produce timethylpsoralen (which is

absent from plants that are not infected) and increased concentrations of 8-MOP. The resulting pink

rot has caused repeated outbreaks of photophytodermatitis in commercial celery handlers [55]. Fungal

infection also has been shown to stimulate a 155-fold increase in furocoumarin production by carrots

(Ceska et al., as cited in Wagstaff 1991 [53], p. 268). There are no FDA regulations or guidelines

specific to the presence of furocoumarins in food.

4.4. Substances formed as the result of processing

4.4.1. Heterocyclic aromatic amines

There are two major classes of heterocyclic aromatic amines (HAAs). Pyrolytic HAAs are formed

from the pyrolysis of amino acids or proteins at high temperature and aminoimidazoarenes (AIAs) are

formed from creatine, free amino acids and monosaccharides, via the Maillard reaction. HAAs are

present in many protein-rich foods of animal origin including cooked meat, fish, poultry and gravies

and sauces derived from pan residues and scrapings of cooked meats. The formation and yield of

HAAs are dependent on cooking temperature and time (concentrations increase with higher

temperatures and longer cooking times), cooking technique and equipment (concentrations of HAAs in

meat are generally higher after grilling and panfrying than broiling or roasting), and the ability of HAA

precursors to migrate to the surface [123].The AIAs 2-amino-3-methylimidazo-[4,5-f]quinoline (IQ), 2-amino-3,4-dimethylimidazo[4,5-f]quinoline

(MeIQ) and 2-amino-3,8,dimethylimidazo[4,5-f]quinoxaline (MeIQx) are among the most potent mutagens

ever tested in the Ames assay. The pyroltic AIA 2-amino-1-methyl-6-phenylimidazol(4,5-b)pyridine (PhIP)

and the HAAs 2-amino-1,4-dimethyl-5H-pyrido[4,3-b]indole (Trp-P-1), 2-amino-4-methyl-5H-

pyrido[4,3-b]indole (Trp-P-2), 2-amino-9H-pyrido[2,3-b]indole (AC), 2-amino-3-methyl-9H-

pyrido[2,3-b]indole (MeAC) are also mutagenic. PhIP accounts for 75% of the mass of genotoxic

material that has been attributed to HAAs in fried ground beef. Therefore, the potential for genotoxicity

due to PhIP may be higher than that of more genotoxic HAAs in meat consumers [123].

Several HAAs are carcinogenic in rodents after long-term dietary administration. The doses required

to induce tumors at a 50% rate (TD50) vary for each HAA, and range from 0.1 to

64.6 mg/kg bw/day [123]. Four HAAs (IQ, MeIQ, MeIQx and PhIP) are reasonably anticipated to be


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human carcinogens [124]. Due to the fact that exposure to HAAs in cooked meats is highly variable

(concentrations in cooked meat may range from


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Figure 5.Structure of acrylamide.

Acrylamide is mutagenic and has been shown to be a neurotoxicant, reproductive toxicant and

carcinogen in experimental animals and is classified by IARC as a probable human carcinogen. The

main metabolite, glycidamide (an epoxide) is thought to be responsible for genotoxicity [127]. In

humans, the only toxicological effect that has been linked to acrylamide is neurotoxicity in individuals

occupationally exposed to high levels. Epidemiological studies have failed to show an increased risk of

cancer from either occupational or dietary exposure to acrylamide and reproductive toxicity has not

been reported in humans exposed to acrylamide [128]. Acrylamide is a unique substance that

exemplifies the concept that the structure of the substance greatly influences the toxicity, as acrylamide

is an animal feed ingredient (thickener and suspending agent) only when a part of a long-chain polymer

having a minimum molecular weight of 3 million and a viscosity range of 3,000 to 6,000 centipoises at

77 F. The residual acrylamide cannot be more than 0.05% (21 CFR 573.120).

In 2005, JECFA estimated that average and high intake consumers ingest 1 o r 4 g/kg bw/day

acrylamide from food, respectively. Using a NOAEL for neurotoxicity of 200 g/kg bw/day in animals,

margins of safety of 200 and 50 for the average and high intake groups were derived, respectively.

Utilizing a benchmark dose of 0.3 mg/kg bw/day and a NOAEL of 2 mg/kg bw/day for development of

mammary tumors or reproductive in rats (respectively), higher margins of safety were calculated for

carcinogenicity (300 and 75, respectively) and reproductive toxicity (200 and 50, respectively) [128].

Exposure to acrylamide can be reduced by avoiding deep-fried foods, soaking potato slices before

cooking, cooking french fries at lower temperatures and to a lighter color, and toasting bread to a

lighter color [127].

4.4.4. Chloropropanols

Chloropropanols are formed in hydrolyzed vegetable proteins (HVP) produced by hydrochloric acid

(HCl) hydrolysis of proteinaceous by-products from edible oil extraction, such as soybean meal,

rapeseed meal and maize gluten [129,130]. The chloropropanol most commonly found in food is

3-MCPD (3-monochloropropane-1,2-diol), although others may also be present, including

2-MCPD (2-monochloropropane-1,3-diol), 1,3-DCP (1,3-dichloro-2-propanol), and 2,3-DCP

(2,3-dichloro-1-propanol) [130]. The two most widely studied chloropropanols are 3-MCPD and

1,3-DCP. It is thought that 3-MCPD is formed as a result of a reaction between a source of chlorine

(chlorinated water or sodium chloride) in a food or a food contact material and a lipid. Two basic

pathways have been proposed: thermally driven and enzyme-catalyzed (generally lipase) reactions.

Direct precursors are thought to be glycerol and chloride. Recent work has also suggested glycidol

(2,3-epoxy-1-propanol) as a precursor. 1,3-DCP is thought to arise from 3-MCPD.

High concentrations of 3-MCPD have been found in acid hydrolyzed HVP (acid-HVP), and soy or

oyster sauce produced using an acid hydrolysis process. Other foods that may contain 3-MCPD are


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cereal, toasted bread, coffee, cheese, licorice, baked goods, processed garlic, liquid smokes, malts,

cured or smoked meat or fish or foods containing acid-HVP as a savory ingredient (soups, prepared

meals, savory snacks, gravy mixes and stick cubes [129132]. Foods containing 1,3-DCP include raw

meat and soy sauce produced using an acid hydrolysis process [129].

In rats and mice, 3-MCPD is toxic to the kidney, producing renal tubule hyperplasia. It is also

carcinogenic in rats when given in high doses over prolonged periods. Although 3-MCPD is genotoxic

in vitro, it is not in vivo. The UK Committee on Carcinogenicity of Chemicals in Food, Consumer

Products and the Environment (COC) has concluded that 3-MCPD is unlikely to present a carcinogenic

risk to man, provided the exposure is 1000 times lower than the no observed effect level (NOEL) of 1.1

mg/kg bw/day for tumorigenicity. JECFA set a tolerable daily intake (TDI) of 2 g

3-MCPD/kg of body weight in 2001 and a maximum allowable content of free 3-MCPD in liquid

condiments at 0.4 mg/kg (400 g/kg) in 2008 [130]. Assuming 400 g/kg3-MCPD is present in soy

sauce, a 60 kg human would have to ingest 300 g of soy sauce (approximately two-thirds of a 444 mLbottle) per day to achieve the TDI. The FDA has provided a policy statement stating that acid-H[V]P or

Asian sauces that contain 3-MCPD at levels greater than 1 ppm are not Generally Recognized As Safe

(GRAS); therefore, these ingredients are unapproved food additives [133].

1,3-DCP is hepatotoxic, genotoxic and induces a variety of different types of tumors in rats.

Therefore, 1,3-DCP is considered to be a potential carcinogen in humans. In 1993, FAO/WHO and

JECFA concluded in that 1,3-DCP is an undesirable contaminant in food and that levels should be

reduced to as low as technologically achievable [131].

4.4.5. Furan

Furan (Figure 6) is a by-product of high-energy and thermal treatment of carbohydrate. Meat and

vegetable containing foods that are heat processed in cans and jars (such as soups, pastas, sauces, gravy

and baby food) and brewed coffee, typically contain the highest concentrations. Concentrations of

furan present in food and coffee range from undetectable to approximately 175 g/kg [134]. Coffee

powders may contain up to 5000 g/kg on a dry weight basis. Although the mechanism of formation of

furan in food is not completely understood, it can be synthesized from vitamin C, amino acids,

reducing sugars, organic acids, carotenes and polyunsaturated fatty acids in the presence of heat [135].

Figure 6.Structure of Furan.

Furan is mutagenic and clastogenic in a number of in vitromammalian cell assays, causes damage to

chromosomes in mice, and is carcinogenic in both rats and mice after oral administration [134,136138].

Furan is classified by IARC as possibly carcinogenic to humans [134].

In the United States and Europe, exposure to furan from food is estimated to be a maximum of

1.00 and 1.75 g/kg bw/day, respectively [134]. The upper estimate of consumption is approximately


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300 and 1000-fold lower than the NOAELs for cytotoxicity and hepatocarcinogenicity of 500 and

2000 g/kg bw in female B6C3F1 mice, determined by Moser et al.[136].

Mitigation of furan in foods is difficult because the mechanism for its formation in food is unclear.

Due to the fact that furan is volatile, it is thought that concentrations can be reduced by heating food in

open containers or leaving ready-to-eat foods open to air after preparation. However, the effectiveness

of this strategy in reducing exposure to furan has yet to be demonstrated [135]. Currently, there are no

FDA regulations specific to the level of furan in food.

4.4.6. Trans fatty acids

Trans fatty acids (also known as trans fat) are the sum of all unsaturated fatty acids that contain one

or more isolated double bonds in a trans configuration. Trans fatty acids more closely resemble

saturated fatty acids than cis unsaturated fatty acids because their trans configuration makes them rigid.

Trans fatty acids in the diet originate from two sources. The first is from bacterial hydrogenation in theforestomach of ruminants, which produces trans fatty acids that are found in beef and mutton fat, milk

and butter. Trans fatty acids are also produced from the hydrogenation of liquid oils (mainly of

vegetable origin). This produces solid fats and partially hydrogenated oils such as margarines, spreads,

shortenings and frying oil, which are more stable than liquid oils [139].

Biochemically, trans-fatty acids act similarly to saturated fatty acids, raising low density lipoprotein

(LDL) cholesterol and decreasing high-density lipoprotein (HDL) cholesterol levels [139]. High

intakes of trans fatty acids have been associated with an increased risk of coronary heart disease (CHD)

independent of other risk factors in large epidemiological studies [140]. A tolerable upper limit of trans

fatty acids has not been set because any incremental increase in the intake of trans fatty acids increases

the risk of coronary heart disease [141].

In the US, the main sources of intake of trans fatty acids are baked goods (28%), fried foods (25%),

margarine, spreads and shortenings (25%), savory snacks (10%), milk and butter (9%) [139]. In 1996,

processed foods and oils accounted for 80% of the trans fat in the diet [141]. In 1999, the FDA

estimated that the average daily intake of trans fat in the United States is about 5.8 grams or 2.6% of

calories per day [142]. It has been hypothesized that replacing 2% energy from trans fatty acids with

2% energy from oleic acid would reduce mean plasma LDL cholesterol concentration by 0.08 mmol/L,

and increase plasma HDL concentration by 0.08 mmol/L. These changes could reduce the incidence of

CHD by 515% [139].

Due to increased efforts by food manufacturers to reduce or eliminate the use of partially

hydrogenated vegetable fat in food production, it is estimated that trans fatty acid content of processed

foods has decreased over the last decade [143].

4.4.7. Nitrosamines formed during drying, curing and preserving

Nitrosamines are formed from the interaction of nitrites or other nitrosating agents with amines in

food (or in vivo), under acidic conditions. Nitrites may be directly added to food or can be formed from

bacterial reduction of nitrate. Nitrites and nitrates may occur naturally in water or foods such as leafy

vegetables due to the use of fertilizer, or may be added to foods to prevent growth of

Clostridium botulinum, or to add color or flavor [144].


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Nitrosamines have been found in a variety of different foods such as cheese, soybean oil, canned

fruit, meat products, cured or smoked meats, fish and fish products, spices used for meat curing, and

beer and other alcoholic beverages [145]. Beer, meat products and fish are considered the main sources

of exposure. Drying, kilning, salting, smoking or curing promotes formation of nitrosamines [146].

The nitrosamines most frequently found in food are nitrosodimethylamine (NDMA),

N-nitrosopyrrolidine (NPYR), N-nitrosopiperidine (NPIP), and N-nitrosothiazolidine (NTHZ) [146].

NDMA, NPYR, NPIP are reasonably anticipated to be human carcinogens based on evidence of

carcinogenicity in experimental animals [145,147,148]. Evidence from case-control studies supports an

association between nitrosamine intake with gastric cancer, but not esophageal cancer in humans [149].

Levels of nitrosamines have been declining during the past three decades, concurrent with a

lowering of the nitrite used in food, use of inhibitors such as ascorbic acid and use of lower operating

temperatures and indirect heating during food processing. Based on an estimated exposure level of

3.35.0 ng/kg bw/day, the and the benchmark lower limit of 60 g/kg bw/day, a margin of errorassociated with a low level of concern (12,00018,2000) has been derived for NDMA, the most

common nitrosamine in food [146].

Although current FDA regulations do not limit nitrosamine levels in foods, the FDA has provided

an action level of 10 ppb for individual nitrosamines in both consumer and hospital rubber baby bottle

nipples, while the FDA limits the approval of nitrites in curing mixes to the FDA-regulated food

additive process (21 CFR 170.60), with the approval of sodium nitrite as a food additive

(food preservative) (21 CFR 172.175). The USDA monitors finished meat products to insure that

nitrite is not present in amounts exceeding 200 ppm (9 CFR 424.21).

4.4.8. Biogenic amines

Biogenic amines are normally formed in humans by normal cellular metabolism. In food, biogenic

amines are mainly formed from microbial decarboxylation of amino acids. They are commonly found

in fermented meat, beverages and dairy products, sauerkraut, and spoiled fish. The main biogenic

amines in food are histamine, tyramine cadaverine, putrescine, spermidine and spermine. The two

biogenic amines that have been associated with acute toxicity are histamine and tyramine. Putresine,

spermine, sperimidine and cadaverine are not toxic in and of themselves, but may react with nitrite or

nitrate to form nitrosamines (see Section 4.4.7 above) [150].

Scombrotoxicosis is a common seafood-borne disease associated with the consumption of toxic

levels of histamine in spoiled scombroid fish such as tuna (Thunnus spp.), mackerel (Scomber spp.),

saury (Cololabis saira) and bonito (Sarda spp.). Red wine may also contain relatively high levels of

histamine. Symptoms of histamine intoxication from food are similar to allergies to other substances

and include sneezing, nose congestion, breathing difficulties and urticaria [150].

Consumption of tyramine may precipitate migraine headache or a hypertensive crisis. The most

serious case reports of tyramine toxicity have occurred in people consuming aged cheese. Because

monoamine oxidase inhibitor (MAOI) drugs inhibit metabolism of amines, people taking these drugs

may be particularly susceptible to tyramine toxicity. Whereas 200800 mg of dietary tyramine inducesonly a mild rise in blood pressure in unmedicated adults, 1025 mg may produce a serious adverse


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event in those taking MAOI drugs. Other potentiating factors for tyramine toxicity include alcohol

consumption, gastrointestinal distress and exposure to other amines [150].

Efforts taken by food manufacturers to reduce biogenic amine concentrations in fermented foods

include using amine-negative starter cultures, adding probiotic bacterial strains alone or in combination

with starter cultures, high pressure processing or low-dose gamma radiation [150]. FDA guidelines

specify 50 mg/100 g as the toxic concentration of histamine in scombroid fish and the agency has

published guidance on how to control levels [151].

5. Substances Passed from Animals to Humans

5.1. Toxins in seafood

5.1.1. Toxins involving algae

Consumption of seafood contaminated with algal toxins results in five different syndromes,

paralytic, neurotoxic, amnesic, or diarrhetic shellfish poisoning and ciguatera fish poisoning [152].

5.1.1.1. Paralytic shellfish poiso

naturally ocurring food toxins

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